Staff will be trained but not professionally qualified, providing everything from ward cleaning and maintenance to bottom wiping, physiotherapy, ECGs and simple X-rays.
The change - which is likely also to hit the private sector - is needed to produce the huge increase in productivity neccessary for the NHS survive and to cope with mounting shortages of doctors, nurses and professional and technical staff, a report from Manchester University's Health Services Management unit said.
The report, launched by the National Association of Health Authorities and produced with the support of the NHS Trust Federation, was greeted with horror by the nursing unions, Christine Hancock, the general secretary of the Royal College of Nursing accusing it of being "out of touch with reality" and warning it could "destroy nursing".
"To suggest that 40 per cent of the 'generic' carers responsible for hands on patient care will be support workers will shock patients and nurses. It flies in the face of the available research about what is best for patients," she said. The proposals had little to do with helping patients "and everything to do with cost cutting".
The report's authors, however, argued the changes were already happening. Far from endangering patients they could improve care, provide more job security, produce new recruits for nursing and medicine and release doctors, nurses and therapists for the tasks which really require their skills.
Over the past decade, the proportion of qualified staff in the NHS has risen, the report says. But there are major shortfalls of doctors in prospect. There is a "nightmare" over recruiting theatre, intensive care and other specialist nurses and difficulties in recruiting occupational and other therapists.
At present, jobs with overlapping skills are divided up "inflexibly", Professor Michael Schofield of the Manchester unit said, with individuals "entering a particular professional box" at age 18 in which they are then stuck for life.
"Multi-skilling" would train support workers in particular occupational skills centred round the patient's needs rather than professional divisions.
Ambulance personnel already show that workers can be trained to be skilled paramedics, and work such as taking blood could be transferred to support workers. That in turn would release nurses.
The range of skills support workers could cover by 2005 include ward housekeeping and cleaning, core nursing such as from bathing and toileting patients, most physiotherapy, admitting and discharging within guidelines, providing discharge and transfer letters, undertaking some pathology tests, and simpler X-rays.
MSF, which represents a range of qualified health care staff, said the change involved "a replacement of skilled with unskilled staff on an unprecedented scale". The report's call for trusts to use local pay to help bring about the changes was also "highly provocative".
However, the UKCC which oversees nurse training, said the report was "timely" and "an interesting contribution to an important debate". Any changes "must be in the best interests of patient care", Sue Norman, its chief executive said.
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